At our Hobart ASM, the society board introduced discipline specific forums to promote stronger communication with our membership and gather feedback regarding issues facing different disciplines. We thank members for their participation and have begun digesting the input we received.
A recurring theme of concern, which prompted a swift response, was your concern about “activity based funding” (ABF) for public hospitals and its pending implementation. We sought some further information and wrote of our society’s concerns to the relevant administrator, the full letter is included in our July 2014 eNewsletter for your consideration. The complexity of the pricing structure and range of organisations involved, their coding manuals and pricing calculations is impressive, and worthy of the significant bureaucratic input which this topic is receiving at federal, state and territory level!
Essentially, the Independent Hospital Pricing Authority (IHPA) is overseeing the establishment of a funding formula for hospital activity, including general inpatient, critical care, emergency department and outpatient clinic activity. It is the latter that is most relevant to outpatient pain management services. This activity, referred to as Non Admitted Patient (NAP) activity is to be coded based on NHCDC (National Hospital Cost Data Collection) – Tier 2 Outpatient Clinic Definitions V2.0. The pain management clinic code (class 20.03) sources NSW and Queensland data collection manuals from 2011, with “usual provider” not listing pain medicine physician. Similarly, the allied health activity is listed in single disciplines under the class 40 grouping, without recognising the multi and interdisciplinary roles of allied health clinicians in pain management. Multi-disciplinary assessments and group activity is not clearly identified, with suggestion that only one client service event can be claimed for multidisciplinary assessments or prolonged activity, although group activity appears to be coded as multiple single client events. In addition, the education and research activity of many multidisciplinary pain services is not well recognised in this service delivery funding model, although some “block funding” arrangements for hospitals may have a role in contributing to the health of a pain service.
The innovation in clinical service delivery models demonstrated by pain management services in Australia over recent years is to be commended and partly reflects historical difficulties in our development (and funding) as a clinical discipline. The society’s approach is to engage the relevant authorities so as to contribute to the refinement of ABF regulations to better reflect our improving models of care delivery, rather than changing our practice to fit outdated classifications. We have received a positive response to concerns raised, such that we are hopeful of contributing to the establishment of appropriate classifications of multidisciplinary pain units for the July 2015 coding systems. I encourage you to consider similar feedback to decision makers and engagement at your local level where relevant.